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Cited by 1,288Diabetes, Cardiovascular Risks, and LipoproteinsDiabetes Management and ResearchHealthcare Systems and Public Health

Mortality and causes of death in the WHO Multinational Study of Vascular Disease in Diabetes

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and the WHO Multinational Study Group, Morrish, N. J., Wang, S.-L., Stevens, L. K., Fuller, J. H., Keen, H.·2001·Diabetologia
DOI 10.1007/pl00002934
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Abstract

Aims/hypothesis We aimed to examine the mortality rates, excess mortality and causes of death in diabetic patients from ten centres throughout the world.Methods A mortality follow-up of 4713 WHO Multinational Study of Vascular Disease in Diabetes (WHO MSVDD) participants from ten centres was carried out, causes of death were ascertained and age-adjusted mortality rates were calculated by centre, sex and type of diabetes. Excess mortality, compared with the background population, was assessed in terms of standardised mortality ratios (SMRs) for each of the 10 cohorts.Results Cardiovascular disease was the most common underlying cause of death, accounting for 44 % of deaths in Type I (insulin-dependent) diabetes mellitus and 52 % of deaths in Type II (non-insulin-dependent) diabetes mellitus. Renal disease accounted for 21% of deaths in Type I diabetes and 11% in Type II diabetes. For Type I diabetes, all-cause mortality rates were highest in Berlin men and Warsaw women, and lowest in London men and Zagreb women. For Type II diabetes, rates were highest in Warsaw men and Oklahoma women and lowest in Tokyo men and women. Age adjusted mortality rates and SMRs were generally higher in patients with Type I diabetes compared with those with Type II diabetes. Men and women in the Tokyo cohort had a very low excess mortality when compared with the background population.Conclusion/interpretation This study confirms the importance of cardiovascular disease as the major cause of death in people with both types of diabetes. The low excess mortality in the Japanese cohort could have implications for the possible reduction of the burden of mortality associated with diabetes in other parts of the world.

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  • Diabetes significantly increases the risk of cardiovascular complications in both sexes, and CVD causes most hospitalizations and deaths in women and men with diabetes.

    “Diabetes signi fi cantly increases the risk of cardiovascular complications in both sexes, and CVD causes most hospitalizations and deaths in women and men with diabetes (280,281).”

    From Management of Hyperglycemia in Type 2 Diabetes, 2022. A Consensus Report by the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD) (2022) · cites this paper as [280]

    The Causes of death section reports cardiovascular disease as the most common cause of death in the diabetes cohorts, and the Discussion says it accounted for a substantial share of deaths in both sexes. The paper does not report hospitalizations or establish a significantly increased risk of cardiovascular complications versus people without diabetes; its comparison with background populations concerns all-cause mortality. (LLM, conf=0.88)

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  • Diabetes is associated with accelerating atherosclerosis and cardiovascular disease, which accounts for 52% of deaths in patients with type 2 diabetes and 44% in patients with type 1 diabetes.

    “It is also associated with an accelerating atherosclerosis and cardiovascular disease,21 23 34 42 which accounts for 52% of deaths in patients with T2D and 44% in patients T1D.3–5”

    From Glycemic variability and cardiovascular disease in patients with type 2 diabetes (2021) · cites this paper as [5]

  • The combination of insulin resistance and hyperinsulinemia disrupts lipid metabolism and increases the risk of cardiovascular disease.

    “The combination of insulin resistance and hyperinsulinemia also disrupts lipid metabolism and increases the risk of cardiovascular disease, the most common source of mortality among individuals with T2D (5).”

    From A Lower-Carbohydrate, Higher-Fat Diet Reduces Abdominal and Intermuscular Fat and Increases Insulin Sensitivity in Adults at Risk of Type 2 Diabetes (2015) · cites this paper as [5]

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Authors
and the WHO Multinational Study Group, Morrish, N. J., Wang, S.-L., Stevens, L. K., Fuller, J. H., & Keen, H.
Affiliations
  • Bedford Hospital (GB)
  • University College London (GB)
  • Guy's Hospital (GB)
Venue
Diabetologia
Publisher
Springer Science and Business Media LLC
Published
2001-09
Volume
44
Issue
S2
Pages
S14-S21
ISSN
  • 0012-186X (ISSN-L)
  • 1432-0428
DOI
10.1007/pl00002934
OpenAlex
W1963542379
Cited by
1,288
References
11
Citations by year
2026: 26 · 2025: 44 · 2024: 72 · 2023: 72 · 2022: 75 · 2021: 86 · 2020: 46 · 2019: 55 · 2018: 68 · 2017: 63 · 2016: 102 · 2015: 84 · 2014: 95 · 2013: 76 · 2012: 50
FWCI
9.48
Type
journal article
Language
en
Open access
Licence
www.springer.com/tdm (tdm)
Locations
  • Diabetologia (publishedVersion)
  • PubMed (publishedVersion)
  • UCL Discovery (University College London) (submittedVersion)
Topics
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
  • Health Sciences › Medicine › Epidemiology › Healthcare Systems and Public Health
Keywords
diabetes mellitus, mortality, causes of death, cardiovascular disease, type 1 diabetes, type 2 diabetes, kidney disease, excess mortality, standardized mortality ratio, sex differences, Japanese cohort
MeSH terms
Cardiovascular Diseases, Cause of Death, Diabetes Mellitus, Type 1, Diabetes Mellitus, Type 2, Diabetic Angiopathies, Diabetic Nephropathies, Female, Humans, International Cooperation, Male, Middle Aged, Neoplasms, World Health Organization

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